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Considerations for ICD-10 Preparation
By David Van Doren, RHIA, CCS, RAC-CT

With the government’s one-year delay in the transition deadline for ICD-10, medical organizations have an opportunity to apply a focused effort toward enhancing overall medical documentation to minimize the impact of the change on their reimbursements. With significantly more codes than its predecessor and, more importantly, an increased level of procedure specificity, ICD-10 will require a greater deal of documentation from the clinician to ensure a smooth transition.

Medical organizations that take full advantage of the ICD-10 transition time allotted will be better able to manage the sizable undertaking and ensure a smooth ICD-10 conversion. They also will be more likely to avoid potentially devastating revenue losses that could result from a poor transition to ICD-10. In addition, they may even be able to start leveraging the processes they establish as part of the transition to improve their competitive advantage in today’s ICD-9 framework, as improved documentation leads to improved coding accuracy and productivity.

Certainly, medical organizations must continue to evaluate and prepare for the unique challenges they will face with the ICD-10 transition. When it comes to actually putting ICD-10 documentation processes in place, hospitals should start by identifying the top 20 most commonly billed diagnoses and procedures in their facility. Then they need to make sure all constituents understand their role in complying with ICD-10 for the documentation of those services. Once ICD-10 processes are established for the top billing codes, those processes can be leveraged to include an expanded list of other hospital services.

Part of establishing processes for ICD-10 will involve looking at current processes and what changes are needed. For instance, with the decreased production that is expected from the increased complexity of ICD-10, coders will be hard pressed to keep up with the coding aspect of their job, making it difficult for them to add retrospective physician queries to their responsibilities. And the more postdischarge queries that have to be written, the longer the patient charts will be held up prior to billing, which will increase the accounts receivable days and slow down the revenue cycle. Hospitals, especially small ones, will not be able to afford that cash flow impact. So they will need to factor efficient collaboration into their overall transition plan and make sure that physicians and coders are on the same page.

While making sure coders and physicians understand the intricacies of ICD-10 and their role in a successful transition, hospitals should not overlook the importance of a clinical documentation improvement (CDI) program to ensure that ICD-10 processes will be properly established and executed. CDI specialists can be very helpful in assuring that proper documentation specificity for diagnostic and procedural coding is obtained before the records are sent for coding, eliminating the need for postdischarge query requests.

Conducting evaluations and establishing processes are critical to ensuring ICD-10 compliance and avoiding financial risk. Properly trained CDI specialists will help minimize the burden of ICD-10 transition preparations and ensure consistency in the established workflow. As such, hospitals with CDI specialists should make sure their programs are being guided by best practices when it comes to ICD-10 preparation. Hospitals without CDI specialists should identify CDI resources that will enable them to implement portions of a CDI program to help them protect revenue at a lower price point. In both cases, focusing on those top 20 billed diagnosis is a great place to start any CDI effort.

Hospitals that do not have CDI specialists are likely to find that coders will be bogged down on the back end with postdischarge queries for additional documentation. Plus the likelihood that information will be entered properly will decrease since it is usually more difficult to obtain documentation after a patient has been discharged.

Still, while it will be more difficult to transition to ICD-10 without the help of CDI specialists, not every hospital can afford to implement a CDI program. Even so, hospitals that are unable to put a complete CDI program into practice should at least consider implementing some aspects of one.

With some level of a CDI program in place, hospitals will be better able to do what needs to be done to prepare for ICD-10. Preparations should include activities such as conducting an on-site review to determine which practices need additional documentation education and training. From there, hospitals will be able to focus their attention on the practices that have the highest impact on revenue. This will enable institutions to minimize the amount of time they spend focusing on specialties that have little to no impact on revenue.

While the adoption date delay from the Centers for Medicare & Medicaid Services may be seen as an opportunity by many organizations to slow down their ICD-10 readiness activities, a more pragmatic approach would be to look at the delay as an opportunity to focus on the completeness of their clinical documentation, which will have the largest financial impact in an ICD-10 framework. The most successful organizations will be those that supplement a basic framework of coder and physician education with a CDI program focused on both improvements in documentation as well as the communication between coders and physicians.

— David Van Doren, RHIA, CCS, RAC-CT, is president of IOD’s coding/HIM consulting/EMR abstraction division.